Anthony S. Fauci, in his last official speaking appearance as director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health (NIH), told first-year students at the George Washington University (GW) School of Medicine and Health Sciences (SMHS) to follow their passions and seize their opportunities, during the school’s Ninth Annual GW Clinical Public Health (CPH) Summit on HIV.
Fauci was joined by Harold Phillips, director of the White House Office of National AIDS Policy, as well as senior HIV/AIDS officials from seven states — Arizona, California, Indiana, Iowa, Maryland, Mississippi, and Tennessee — and the District of Columbia, for the event titled, How Clinicians Can Help End the HIV Epidemic: Prescriptions for State and City Action Plans. The event is the first in a series of annual clinical public health education summits designed to prepare students in the SMHS MD program for the roles they will need to take on as physicians to improve community health. SMHS began incorporating rigorous clinical public health education into the MD program curriculum in 2014. Since then, these summits — which include the topics of asthma and obesity in addition to HIV — serve as the cornerstone of the CPH curriculum, offering applied educational experiences enabling students to develop the public health leadership and interprofessional skills needed to identify, understand, and improve community health issues both within and beyond the walls of the clinic.
Over the course of the three-day summit in December, students broke into teams to craft strategic plans tailored to the HIV/AIDS epidemic patterns, health system capabilities, and community factors specific to their assigned jurisdictions. On the final day, they presented their plans to a panel of academic, federal and state experts, receiving advice and feedback on their strategies.
“I think this type of summit could not be a better way for you to culminate this first 14 weeks of your life as a young physician,” said Barbara L. Bass, MD, RESD ’86, Bloedorn Professor of Administrative Medicine, vice president for health affairs, dean GW SMHS, and CEO of The GW Medical Faculty Associates. “The notion of being able to take care of populations and communities with a different set of tools to use for advocacy … is really going to be make you a different type of physician for the communities that you serve. I hope you that will never let that principle go, and will use that really wisely throughout your careers.”
Lessons for the Future
As he has done since SMHS launched the HIV Summit, Fauci offered the first-year medical students lesson he learned that has helped shape his career, ultimately serving as a key adviser on HIV AIDS issues to seven presidents, an architect of PEPfAR (the President’s Emergency Plan for AIDS Relief), and possibly the world’s most identifiable figure in medicine and public health.
“People see me now is the head of a research institution, they think that I was doing research from the time I entered into college. That was not the case,” explained Fauci. “I didn’t have a linear pathway to where I got. There were things that occurred that I never would have predicted and there were opportunities that popped up in front of me that made me change the direction of my career.”
Following a fellowship at NIH, under the mentorship of Sheldon M. Wolff, MD, Fauci’s career took off and he found early success and quickly moved up the research ladder from a clinical associate, then senior investigator, and ultimately running his own lab developing therapies for vasculitis syndromes while at NIH.
In June 1981, however, that career trajectory took a turn. The journal Morbidity Mortality Weekly reported on five gay men from Los Angeles who had all contracted Pneumocystis, a serious fungal infection in the lungs. A month later the journal ran a similar report, this time with 26 gay men, not only from Los Angeles, but also New York City and San Francisco, suffering from pneumocystis, kaposi sarcoma, an unusual kind of cancer as well as an array of other opportunistic diseases.
“I got goose pimples,” recalled Fauci. “I said, ‘oh, my goodness, we’re dealing with a brand new disease!’ Whoever heard of a brand new disease that no one had ever really experienced before?”
That moment marked a shift in Fauci’s career, and the beginning of a 40-year journey researching HIV.
“If you get one message from my discussion today,” Fauci told the students, “it’s that lot of things are going to pop up in front of you and you should really take a look and consider possibility of taking advantage of them.”
Illustrating another important lesson learned, Fauci recalled an incident that opened his eyes to the vital role community engagement can play in the scientific process. In 1988, Larry Kramer, playwright, film producer, and co-founder of both the Gay Men’s Health Crisis and Act Up, published a scathing rebuke of the early research response to the HIV epidemic. Kramer called out Fauci by name in an editorial that appeared on the front page of the San Francisco Examiner titled, “I Call You Murderers: An Open Letter to an Incompetent Idiot, Dr. Anthony Fauci of the NIH.”
At the time, Fauci said, AIDS activists thought HIV wasn’t a high priority for the U.S. government and researchers weren’t including the community in the planning of clinical trials and in the regulatory process. Those activists, he said, were correct. Rather than ignore Kramer and the AIDS activists, Fauci chose to embrace the opportunity to meet, leading to more productive interactions among community members and scientists and regulators.
“I believe [that] was one of the best things I ever did,” he said. “I engaged these men and women who were marching against the government rigidity. This was not the kind of hate and threats that we see now in science. These activists wanted science to work for them and to work faster. This was good stuff. This was trying to gain our attention to tell us, please listen to us.”
Laying Out a National Strategy
In his remarks, Harold Phillips, director of the White House Office of National AIDS Policy, primed the students for their summit assignment, offering an overview of the U.S. national strategy on HIV and the Biden Administration’s efforts to address the 40-year pandemic.
The strategy targets four key goals, the prevention of new infections, improving HIV-related health outcomes, reducing HIV-related disparities, and integrating coordinated efforts to address the epidemic.
“In terms of HIV in the United States today, there are 1.2 million people living with HIV, but nearly one in eight have not been diagnosed,” Phillips said. However, each year there are roughly 35,000 new infections. Stigma and discrimination, he explained, as well as lack of awareness that HIV is still impacting many people the United States today are likely to blame despite successful treatments that have changed HIV infection from a rapidly fatal diagnosis into a treatable chronic disease. Treatment can lower viral loads to undetectable, and therefore untransmissible, levels stopping the spread of this virus.
“Our goal by the year 2030 is to decrease the number of new infections down to 3,000 or less,” Phillips said.
In order to achieve that reduction in cases by 2030, what he called “public health epidemic control,” Phillips said every person needs to know their status and every person with HIV needs to be receiving high-quality care and treatment. “This vision includes all people, regardless of age, sex, gender identity, sexual orientation, race, ethnicity, religion, disability, geographic location or socio-economic circumstances what they are, living free from stigma and discrimination and can achieve their full potential for health and well-being across the lifespan.”
A Charge to the Class of 2026
In his remarks to the students before the start of the summit, Lawrence Deyton, MSPH, MD ’85, senior associate dean for clinical public health at SMHS and professor of medicine and public health, reminded the students how far things have come since the early days of the epidemic. From the early 1980s, when HIV and AIDS were first identified, the infection has gone from being a uniformly fatal disease to a chronic, treatable and preventable condition.
“It’s my generation of physicians and activists really took the first steps to understand HIV and what it does to the body, and then how to treat it and how to prevent HIV infection,” Deyton said. “That brings us to the challenge of today. We’ve got all the tools to prevent every HIV infection. We’ve got the tools to turn HIV into a treatable, chronic disease. We may even have the tools soon to completely eliminate HIV infection. The tools are in your hands, it’s your responsibility now to end the HIV epidemic. You’re ready to begin.”